Assessment
LOC, pulse, BP, RR, mucous membranes, skin turgor, cap. refill, I&O hx
Describe components of an assessment of fluid status in a child.
apricots, bananas, orange juice
What are 3 nutritional sources of potassium?
Give the 24 hour maintenance fluid amount (ml) for a 15 kg child.
1000 + 250 = 1250 ml
75%
A full-term newborn infant is what percentage water by body weight.
Sunken anterior fontanel
What is a finding on an infant when they are severely dehydrated?
Inappropriate mixing/overdiluting of powdered formula, infant vomiting and given tap water, excessive swallowing of swimming pool water
What are potential causes for a hyponatremia in an infant?
Give the hourly IV rate for a 10 kg infant who is NPO.
1000 divided by 24 = 41.6 or 42 ml/hr or 4 x 10 = 40 ml/h
More extracellular fluid than intracellular fluid.
Name the difference between a baby and an adult in terms of intracellular and extracellular fluid proportions.
Name (4) signs and symptoms in a 2 year old with a 10% weight loss due to dehydration.
Lethargic to comatose; rapid, weak pulse; changing RR and resp. pattern, low BP; parched mucous membranes; poor skin turgor; delayed cap. refill (> 3-4 secs); very decreased or absent urine output;
Furosemide, glucocorticoid or IV penicillin administration, NG suctioning, vomiting
What are possible causes of hypokalemia in a hospitalized child?
Name the percent of weight loss with a weight change from 15kg to 13kg.
2 divided by 15 = 0.13 x 100 = 13%
Kidneys are immature ; more insensible water loss through the skin; higher RR leads to more insensible water loss from lungs; higher metabolic rate
What are reasons why infants and young children can become dehydrated more quickly than adults?
Identify 2 problems that might show up in parents’ history or your PE of a young infant with dehydration.
LOC is hard to assess; parent may not be able to tell you number of diapers or accurate intake
tetany; twitching and cramping, tingling around the mouth or in the fingers, hypotonicity
What are signs and/or symptoms of hypocalcemia?
Teach the parent how many 8 oz. bottles are needed to meet the maintenance fluid requirements for a 12 kg. 1 year old.
Maintenance fluids = 1000 + 100 = 1100 ml
8 oz. = 240 ml
1100 divided by 240 = 4.5 bottles in 24 hours.
(Or convert 1100 to oz.= 36.6 oz in 24 hours
36.6 divided by 8 oz/bottle = 4.5 bottles in 24 hours.)
Children under 2 years of age have difficulty regulating which specific electrolyte?
Sodium
Use a pump and buretrol setup; no more than 2 hours fluid available via buretrol; site check q 1h; double check rate and pump; use of arm/foot board to prevent dislodging/dc'ing IV, parent education
Identify safety precautions used with intravenous fluid therapy in a baby.
Monitor serum electrolytes, assess muscle strength, monitor cardiac status, monitor GI motility, administer fluids and meds as ordered
What are nursing interventions for a child with hyperkalemia?
Calculate IV replacement therapy for a 12 kg child with a 8% weight loss. (moderate dehydration).
Maintenance fluid + (8 x 10)/kg/24hr = 24 hour fluid needs
1000ml + (50 x 2) = 1100 maintenance
80 x 12 = 960 replacement
1100 + 960 = 2060 ml
give fluids frequently in small amounts at a time; do not use sugary or carbonated beverages; call if no urine output in 4-6 hours, lethargic, V&D continue or for other changes or concerns
What are nursing interventions to teach a parent appropriate oral rehydration therapy for a child with mild to moderate dehydration?